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In patients with moderate to severe atopic dermatitis (AD) showing an inadequate response to dupilumab 300mg/2weeks, few real-life studies reported the response to alternative regimen maintaining dupilumab.To assess and analyze the response to an increased dose of dupilumab or its combination with cyclosporin A (CsA), methotrexate (MTX), or itraconazole (ITRA), all adult AD patients from 7 French University Hospitals were retrospectively included if they achieved an inadequate response to dupilumab 300mg/2weeks and were subsequently treated with an increased dose of dupilumab (300mg every 7 or 10 days), or a combination of dupilumab 300mg/2weeks with CsA, MTX or ITRA. The response after 3 months, along with epidemiological, clinical, and therapeutic baseline characteristics, were collected.Overall, 68.75% of the 48 included patients achieved an improved response, including 45.8% of complete response (CR). No strategy proved significantly better. Patients showing an initial no response never achieved a further CR versus 52.4% of patients with an initial partial response (p = 0.025). Digestive intolerance and tachycardia led to MTX and ITRA discontinuation in 3 patients.Increasing the dose of dupilumab or combining it with CsA, MTX, or ITRA could be alternative and safe options, to be evaluated in further medico-economic studies.

The objective was to investigate the possibility of using ExacTrac X-ray (ETX) for 6D image guidance in stereotactic body radiation therapy (SBRT) of bone metastasis and to propose a patient management protocol. The analyses were first obtained from measurements on a pelvic phantom and on 19 patients treated for bone metastasis. The phantom study consisted of applying known offsets and evaluating the ETX level of accuracy, where results were compared with kV-cone beam computed tomography (kV-CBCT). Two groups of patients, 10 spinal and 9 nonspinal SBRT cases, were analyzed to evaluate ETX imaging for different bone localisations. A comparison was made between kV-CBCT and ETX prior to the treatment fractions. During treatments, two other kV-CBCT/ETX image pairs were also acquired and a total of 224 shifts were compared. A second study, using the ETX monitoring module, analyzed the intrafraction motion of 8 other patients. In the phantom study, the root mean square (RMS) of the translational and rotational discrepancies between ETX and kV-CBCT were

The impacts of poor air quality on human health are becoming more apparent. Businesses and governments are implementing technologies and policies in order to improve air quality. Despite this the PM 10 air quality in the mining town of Moranbah, Australia, has worsened since measurements commenced in 2011. The annual average PM 10 concentrations during 2012, 2017, 2018 and 2019 have all exceeded the Australian National Environmental Protection Measure's standard, and there has been an increase in the frequency of exceedances of the daily standard. The average annual increase in PM 10 was 1.2 ± 0.5 μg m - 3 per year between 2011 and 2019 and has been 2.5 ± 1.2 μg m - 3 per year since 2014. The cause of this has not previously been established. Here, two machine learning algorithms (gradient boosted regression and random forest) have been implemented to model and then meteorologically normalise PM 10 mass concentrations measured in Moranbah. The best performing model, using the random forest algorithm, was able to explain 59% of the variance in PM 10 using a range of meteorological, environmental and temporal variables as predictors. An increasing trend after normalising for these factors was found of 0.6 ± 0.5 μg m - 3 per year since 2011 and 1.7 ± 0.3 μg m - 3 per year since 2014. These results indicate that more than half of the increase in PM 10 is due to a rise in local emissions in the region. The remainder of the rise in PM 10 was found to be due to a decrease of soil water content in the surrounding region, which can facilitate higher dust emissions. Whether the presence of open-cut coal mines exacerbated the role of soil water content is unclear. Although fires can have drastic effects on the local air quality, changes in fire patterns are not responsible for the rising trend. PM 10 composition measurements or more detailed data relating to local sources is still needed to better isolate these emissions. Nonetheless, this study highlights the need and potential for action by industry and government to improve the air quality and reduce health risks for the nearby population., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The author has family members that live in the town that is the focus of this study and employed in local industry. These personal relationships did not influence the analyses or discussion presented in this study in any way., (© 2020 Turkish National Committee for Air Pollution Research and Control. Production and hosting by Elsevier B.V. All rights reserved.)